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Treatment for Relapsed Follicular Lymphoma

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Published on October 1, 2021

Doctor Explains Treatment for Relapsed Follicular Lymphoma

What therapies are available for follicular lymphoma at the time of relapse? Hear Brian T. Hill, MD, PhD, of the Cleveland Clinic Taussig Cancer Institute explain each treatment option and share advice for follicular lymphoma patients who have relapsed.

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Transcript | Treatment for Relapsed Follicular Lymphoma

What’s New for Patients Who Have Relapsed?

Dr. Hill: Yeah. So, for follicular lymphoma, as you're probably aware, we have a lot of good treatment options for the frontline. So, many people will receive rituximab, or Rituxan, with chemotherapy. The traditional chemotherapy that would be given with Rituxan, which is an antibody, would be bendamustine (Bendeka and Treanda) frequently, sometimes CHOP. So we call that BR or R-CHOP. And if the follicular lymphoma comes back as it eventually probably will, depending on the timing of that, there are a lot of different treatment options and can depend on how old you are and so forth. But some of the common things that are done at the time of relapse include just Rituxan by itself or Rituxan in combination with Revlimid, or lenalidomide. So, Revlimid is a pill which is taken usually by mouth every day for three weeks in a row. It has some side effects, like it can cause some GI disturbances, rash, sometimes change the blood counts a little bit, but it's generally pretty well tolerated.

If that's given with rituximab, or Rituxan, the two work quite well together. So that regimen is called R-squared because it's two drugs that start with letter R. There are many others out there, mostly what I would say, there's a whole class of medications called the PI3 kinase inhibitors and those are oral agents. The newest one out there is something called umbralisib (Ukoniq), which is a pill that is generally well-tolerated, sometimes can cause diarrhea, but usually pretty mild. There's another one out there recently approved, tazemetostat (Tazverik), which is also an oral medication, it's very well-tolerated, sometimes can cause low blood counts, but overall is very effective and maybe an option for patients. I'll just mention briefly in a, at the end that there are cell therapies, your audience is probably familiar with CAR T-cell. CAR T-cell is an option now for follicular lymphoma as well.

What Should a Follicular Lymphoma Patient Be Asking Their Doctor?

Dr. Hill: Yeah. You know what I would say for follicular lymphoma is that it's, there's no one right answer and a lot of it depends on how old you are, how long your remission was, what your prior treatment was. And the length of the remission isn't really a big determinant of what options may be in terms of how aggressive or are sort of less aggressive to be. And so, asking your oncologist about all of these options, targeted agents, cell therapy, transplant, are those things to consider? Is it worth consulting with a specialist who does new focuses on lymphoma before making a decision about the next line of treatment?

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